Surveillance Imaging in Patients with Endometrial Cancer in First Remission

Publication date: Available online 24 August 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Yazan Z. Alabed, Su-Chun Cheng, LCDR Christopher Mudge, Christopher Sakellis, Annick D. Van den Abbeele, Susana M. Campos, Heather A. Jacene
ObjectiveThe clinical benefit of surveillance imaging in endometrial cancer remains undefined. This retrospective study was conducted to evaluate the positive predictive value (PPV) of surveillance imaging in endometrial cancer.Methods128 in first remission after treatment for endometrial cancer (uterine papillary serous, clear cell, stage III endometroid) who had surveillance imaging were retrospectively identified. The surveillance period was defined from the time of first negative scan after treatment to the time when treatment was started for recurrent disease. Reports of surveillance scans were reviewed for the presence or absence of findings. The primary outcome was PPV of surveillance imaging. Cost and radiation exposure from surveillance imaging were also evaluated.ResultsOne hundred twenty-eight patients had 707 surveillance scans (CT, FDG-PET/CT, MRI, bone scans). Median follow-up was 54 months (range 9–173). Forty-seven patients (37%) started therapy for recurrent endometrial cancer at the discretion of the treating physician. PPV of all surveillance imaging was 57.7%. Per patient, the mean number of surveillance scans was 5.6 (range 2–21). The mean cost of imaging was $4,200 (range $1,200–18,700) and mean radiation exposure was 109.6 mSV (range 16–445mSv).ConclusionsSurveillance imaging detected a significant number of recurrences in patients with high-risk endometrial cancer at a reasonable cost related to the overall risk. Well-designed prospective imaging trials are warranted to assess the clinical benefit of surveillance imaging.



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